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Scognamiglio F, Pizzolitto C, Romano M, Teti G, Zara S, Conz M, Donati I, Porrelli D, Falconi M, Marsich E. "A lactose-modified chitosan accelerates chondrogenic differentiation in mesenchymal stem cells spheroids". Biomater Adv 2024; 160:213849. [PMID: 38599041 DOI: 10.1016/j.bioadv.2024.213849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Spheroids derived from human mesenchymal stem cells (hMSCs) are of limited use for cartilage regeneration, as the viability of the cells progressively decreases during the period required for chondrogenic differentiation (21 days). In this work, spheroids based on hMSCs and a lactose-modified chitosan (CTL) were formed by seeding cells onto an air-dried coating of CTL. The polymer coating can inhibit cell adhesion and it is simultaneously incorporated into spheroid structure. CTL-spheroids were characterized from a morphological and biological perspective, and their properties were compared with those of spheroids obtained by seeding the cells onto a non-adherent surface (agar gel). Compared to the latter, smaller and more viable spheroids form in the presence of CTL as early as 4 days of culture. At this time point, analysis of stem cells differentiation in spheroids showed a remarkable increase in collagen type-2 (COL2A1) gene expression (~700-fold compared to day 0), whereas only a 2-fold increase was observed in the control spheroids at day 21. These results were confirmed by histological and transmission electron microscopy (TEM) analyses, which showed that in CTL-spheroids an early deposition of collagen with a banding structure already occurred at day 7. Overall, these results support the use of CTL-spheroids as a novel system for cartilage regeneration, characterized by increased cell viability and differentiation capacity within a short time-frame. This will pave the way for approaches aimed at increasing the success rate of procedures and reducing the time required for tissue regeneration.
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Affiliation(s)
- F Scognamiglio
- Department of Life Sciences, University of Trieste, Via Licio Giorgieri 5, 34127 Trieste, Italy.
| | - C Pizzolitto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazza dell'Ospitale 1, 34129 Trieste, Italy.
| | - M Romano
- Department of Life Sciences, University of Trieste, Via Valerio 28, 34127 Trieste, Italy.
| | - G Teti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Irnerio 48, 40126 Bologna, Italy.
| | - S Zara
- Department of Pharmacy, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
| | - M Conz
- Department of Life Sciences, University of Trieste, Via Licio Giorgieri 5, 34127 Trieste, Italy.
| | - I Donati
- Department of Life Sciences, University of Trieste, Via Licio Giorgieri 5, 34127 Trieste, Italy.
| | - D Porrelli
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazza dell'Ospitale 1, 34129 Trieste, Italy.
| | - M Falconi
- Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126 Bologna, Italy.
| | - E Marsich
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazza dell'Ospitale 1, 34129 Trieste, Italy.
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Re C, Belladelli F, Cei F, Salerno L, Cusano S, Innace F, Pipitone G, Carrera P, Russo Raucci A, Patricelli M, Falini A, De Cobelli F, Mortini P, Bandello F, Lattanzio R, Falconi M, Partelli S, Necchi A, Marandino L, Rowe I, Montorsi F, Capitanio U, Larcher A, Salonia A. Deciphering the relationship between pathogenic variants and clinical phenotype in VHL patients: Results from a prospective observational study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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3
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Cei F, Re C, Belladelli F, Fallara G, Salerno L, Cusano S, Innace F, Falini A, Calloni S, De Cobelli F, Guazzarotti G, Mortini P, Capitanio J, Bailo M, Bandello F, Lattanzio R, Falconi M, Partelli S, Muffatti F, Rowe I, Montorsi F, Capitanio U, Larcher A, Salonia A. Surveillance interruption and need for active treatment in Von Hippel-Lindau disease: A prospective study from a multidisciplinary program. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Del Castillo S, Llamedo C, Capdeville S, Fileni L, Scarponi C, Belziti C, Rossi E, Falconi M, Perez De Arenaza D, Pizarro R. Usefulness of ultra-sensitive troponin to predict anthracyclines and trastuzumab related cardiac dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cancer therapeutics–related cardiac dysfunction usually known as cardiotoxicity (CTX) is a common adverse effect of anthracyclines and anti-Her2 agents. In recent years, evidence of usefulness of ultrasensitive troponin for early diagnosis of CTX has increased, however the cut-off values of this biomarker remain uncertain.
Purpose
To assess the usefulness of ultrasensitive troponin T (UsTnT) to identify patients at risk of developing CTX and determine cut-off values for this biomarker.
Methods
Patients with diagnosis of solid or hematologic malignancies scheduled to receive therapy including anthracyclines and/or trastuzumab were prospectively included. Echocardiogram was performed prior to chemotherapy, and repeated 3 and 6 months later. UsTnT was measured at baseline and 3 months after starting chemotherapy and the increase of this biomarker from baseline was calculated. This UsTnT has a range of 3–10,000 pg/mL with a 99th percentile <15 pg/mL. Receiver operating characteristic curve was used to find out the best cut-off values followed by a multivariate analysis. The primary endpoint was the presence of CTX defined as a decline of left ventricular ejection fraction (LVEF) ≥10% at 6 months from baseline.
Results
A total of 141 patients were included (mean age 56±15 years, 85,8% were women, the most frequent diagnosis being breast cancer: 61.7%). Thirty-three patients (23.4%) met criteria of the primary endpoint of CTX. Patients with CTX showed significantly higher values of UsTnT at 3 months (18.2±14,9 vs 11.8±10,7 pg/mL, p=0.008) and also showed a higher increase of UsTnT from baseline (11.8±12.8 vs 5±8.2 pg/ml, p<0.001) (figure 1).
The value of UsTnT at 3 months ≥13 pg/mL and an increase of UsTnT from baseline ≥14 pg/mL were selected as the best cut-off values. Figure 2 resumes sensitivity, specificity and predictive values. Those patients who had UsTnT at 3 months ≥13 pg/mL had a 3.8 fold increased risk of developing CTX in a multivariate analysis adjusted by age and left ventricular hypertrophy (OR: 3.8 [95% CI: 1.6–9.3], p=0.003) while an increase of UsTnT from baseline ≥14 pg/mL showed almost 12 fold increased risk for the primary endpoint in the same model (OR: 11.95 [95% CI: 3.9–36.6], p<0.001).
Conclusions
UsTnT is a good biomarker for detecting early myocardial injury which allows the identification of patients at risk for developing CTX with only two measurements during cancer treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Del Castillo
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | - C Llamedo
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | - S Capdeville
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | - L Fileni
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | - C Scarponi
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | - C Belziti
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | - E Rossi
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | - M Falconi
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
| | | | - R Pizarro
- Italian Hospital of Buenos Aires , Buenos Aires , Argentina
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Del Castillo S, Fileni L, Llamedo C, Capdeville S, Scarponi C, Belziti C, Falconi M, Perez De Arenaza D, Rossi E, Pizarro R. Response to heart failure treatment in patients with anthracyclines and trastuzumab induced left ventricular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chemotherapy treatments with anthracyclines and Trastuzumab are widely used in different hematologic or solid malignancies but myocardial injury and left ventricular dysfunction, usually called cardiotoxicity (CTX), is a frequent adverse effect. Some studies have demonstrated that early detection and treatment of CTX is essential for the recovery of left ventricular ejection fraction (LVEF), however its behavior after starting treatment is not well established.
Purpose
Evaluate the behavior of LVEF after starting treatment for heart failure in patients with diagnosis of CTX.
Methods
Patients with diagnosis of solid or hematologic malignancies scheduled to receive therapy including anthracyclines and/or trastuzumab were prospectively included. Echocardiogram was performed before starting treatment, and then 3 and 6 months after. CTX was defined, according to guidelines, as a drop of LVEF ≥10% to a value <53% and in these patients treatment of left ventricular dysfunction with B blockers and Enalapril/Losartan was promptly initiated and up-titrated to the maximal tolerated dose. Myocardial injury was defined as a drop of LVEF ≥10% and a value ≥53%, with a watchful waiting strategie, considering these patients as a control group. LVEF was re-evaluated 6 months after starting treatment or after diagnosis of myocardial injury. Primary endpoint was defined as a recovery of LVEF ≥10%.
Results
Of a total of 141 patients of the entire cohort (mean age 56±15 years, 85,8% women and 61,7% with diagnosis of breast cancer),17 patients (12%) met criteria of CTX and 21 (14,9%) of myocardial injury. There were no differences in relation to clinical characteristics or chemotherapy schemes between groups. In patients with CTX (intervention group), 88,2% reached the primary endpoint of recovery of LVEF ≥10% while only 23,8% did it in the control group (p<0,001). Patients with CTX had lowest LVEF at baseline, however no significant differences were observed at 12 months of follow up. Figure 1 represents the behavior of LVEF at baseline, 3, 6 and 12 months. A paired before-after analysis was performed between LVEF at baseline and at 12 months. Patients who received treatment showed no differences in LVEF (63,3±7,2% vs 61,5±9,6%, p=0,5). In contrast, patients who did not receive treatment showed a significant drop in LVEF (72,7±4,4% vs 66,2±5,4%; p<0,001) (figure 2).
Conclusion
Treatment of left ventricular dysfunction in patients with CTX is associated with a greater recovery of LVEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Del Castillo
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - L Fileni
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - C Llamedo
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - S Capdeville
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - C Scarponi
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - C Belziti
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - M Falconi
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | | | - E Rossi
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
| | - R Pizarro
- Italian Hospital of Buenos Aires, Cardiology , Buenos Aires , Argentina
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Redegalli M, Schiavo Lena M, Cangi MG, Smart CE, Mori M, Fiorino C, Arcidiacono PG, Balzano G, Falconi M, Reni M, Doglioni C. Proposal for a New Pathologic Prognostic Index After Neoadjuvant Chemotherapy in Pancreatic Ductal Adenocarcinoma (PINC). Ann Surg Oncol 2022; 29:3492-3502. [PMID: 35230580 PMCID: PMC9072515 DOI: 10.1245/s10434-022-11413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/16/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Limited information is available on the relevant prognostic variables after surgery for patients with pancreatic ductal adenocarcinoma (PDAC) subjected to neoadjuvant chemotherapy (NACT). NACT is known to induce a spectrum of histological changes in PDAC. Different grading regression systems are currently available; unfortunately, they lack precision and accuracy. We aimed to identify a new quantitative prognostic index based on tumor morphology. PATIENTS AND METHODS The study population was composed of 69 patients with resectable or borderline resectable PDAC treated with preoperative NACT (neoadjuvant group) and 36 patients submitted to upfront surgery (upfront-surgery group). A comprehensive histological assessment on hematoxylin and eosin (H&E) stained sections evaluated 20 morphological parameters. The association between patient survival and morphological variables was evaluated to generate a prognostic index. RESULTS The distribution of morphological parameters evaluated was significantly different between upfront-surgery and neoadjuvant groups, demonstrating the effect of NACT on tumor morphology. On multivariate analysis for patients that received NACT, the predictors of shorter overall survival (OS) and disease-free survival (DFS) were perineural invasion and lymph node ratio. Conversely, high stroma to neoplasia ratio predicted longer OS and DFS. These variables were combined to generate a semiquantitative prognostic index based on both OS and DFS, which significantly distinguished patients with poor outcomes from those with a good outcome. Bootstrap analysis confirmed the reproducibility of the model. CONCLUSIONS The pathologic prognostic index proposed is mostly quantitative in nature, easy to use, and may represent a reliable tumor regression grading system to predict patient outcomes after NACT followed by surgery for PDAC.
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Affiliation(s)
- M Redegalli
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Schiavo Lena
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M G Cangi
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - C E Smart
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Mori
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - C Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - P G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - G Balzano
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Pancreas Translational and Clinical Research Centre, Milan, Italy.
| | - C Doglioni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Andreasi V, Partelli S, Manzoni MF, Muffatti F, Di Filippo L, Crippa S, Corti A, Falconi M. Role of chromogranin A-derived fragments after resection of nonfunctioning pancreatic neuroendocrine tumors. J Endocrinol Invest 2022; 45:1209-1217. [PMID: 35122631 DOI: 10.1007/s40618-022-01750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE No single reliable biomarker is available for nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs). Vasostatin-1 (VS-1), the N-terminal fragment of chromogranin A (CgA), seems to be a more accurate biomarker compared to its precursor. Primary aim was to investigate the ability of VS-1, compared to total-CgA, to assess the effectiveness of surgical resection performed for NF-PanNETs. Secondary aim was to evaluate two additional CgA-derived fragments, pancreastatin (PST) and vasostatin-2 (VS-2), as possible biomarkers for NF-PanNETs. METHODS Consecutive patients who underwent surgery for NF-PanNETs at San Raffaele Scientific Institute were included (n = 35). Plasma levels of CgA and CgA-derived fragments were measured by Enzyme-Linked ImmunoSorbent Assay (ELISA), preoperatively and postoperatively. RESULTS Preoperative VS-1 was significantly higher compared to VS-1 measured on postoperative day 5 (POD5) (pre: 0.338 nM versus POD5: 0.147 nM, P < 0.001), whereas total-CgA significantly increased after surgery (pre: 1.123 nM versus POD5: 1.949 nM, P = 0.006). Overall, 24 patients showed ≥ 1 feature of tumor aggressiveness (T3-T4, nodal/distant metastases, Ki67 > 5%, microvascular/perineural invasion, necrosis). The median percentage decrease in VS-1 plasma levels was 63% (IQR 28-88%) among patients with aggressive tumors, compared to 13% (IQR 0-57%) in the remaining population (P = 0.033). No significant differences in terms of PST (P = 0.870) and VS-2 (P = 0.909) were observed between preoperative and postoperative time. CONCLUSION VS-1 provides an early assessment of surgical efficacy in patients who undergo resection for NF-PanNETs, especially in those with aggressive neoplasms. Total-CgA, PST and VS-2 have no clinical utility in this setting.
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Affiliation(s)
- V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy
- Tumor Biology and Vascular Targeting Unit, Experimental Oncology Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy
| | - M F Manzoni
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy
- Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Muffatti
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy
| | - L Di Filippo
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy
- Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy
| | - A Corti
- Vita-Salute San Raffaele University, Milan, Italy
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy
- Tumor Biology and Vascular Targeting Unit, Experimental Oncology Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), Milan, Italy.
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Andreasi V, Ricci C, Partelli S, Guarneri G, Ingaldi C, Muffatti F, Crippa S, Casadei R, Falconi M. Predictors of disease recurrence after curative surgery for nonfunctioning pancreatic neuroendocrine neoplasms (NF-PanNENs): a systematic review and meta-analysis. J Endocrinol Invest 2022; 45:705-718. [PMID: 34773595 DOI: 10.1007/s40618-021-01705-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients submitted to curative surgery for non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs) exhibit a variable risk of disease relapse. Aims of this meta-analysis were to estimate the rate of disease recurrence and to investigate the risk factors for disease relapse in patients submitted to curative surgery for NF-PanNENs. METHODS Medline/Pubmed and Web of Science databases were searched for relevant studies. A meta-regression analysis was performed to investigate the source of recurrence rate heterogeneity. Pooled hazard ratios (HRs) and 95% confidence intervals (95% CI) were used to assess the effect of each possible prognostic factor on disease-free survival. RESULTS Fifteen studies, involving 2754 patients submitted to curative surgery for NF-PanNENs, were included. The pooled rate of disease recurrence was 21% (95% CI 15-26%). Study quality (Odds ratio, OR 0.94, P = 0.016) and G3-PanNENs rate (OR 2.18, P = 0.040) independently predicted the recurrence rate variability. Nodal metastases (HR 1.63, P < 0.001), tumor grade G2-G3 (G1 versus G2: HR 1.72, P < 0.001, G1 versus G3 HR 2.57, P < 0.001), microvascular (HR 1.25, P = 0.046) and perineural (HR 1.29, P = 0.019) invasion were identified as significant prognostic factors. T stage (T1-T2 versus T3-T4, P = 0.253) and status of resection margins (R0 versus R1, P = 0.173) did not show any significant relationship with NF-PanNENs recurrence. CONCLUSION Disease relapse occurs in approximately one out of five patients submitted to curative surgery for NF-PanNENs. Nodal involvement, tumor grade, microvascular and perineural invasion are relevant prognostic factors, that should be taken into account for follow-up and for possible trials investigating adjuvant or neoadjuvant treatments.
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Affiliation(s)
- V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - C Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - G Guarneri
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - F Muffatti
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - R Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Mapelli P, Bezzi C, Palumbo D, Canevari C, Ghezzo S, Samanes Gajate AM, Catalfamo B, Messina A, Presotto L, Guarnaccia A, Bettinardi V, Muffatti F, Andreasi V, Schiavo Lena M, Gianolli L, Partelli S, Falconi M, Scifo P, De Cobelli F, Picchio M. 68Ga-DOTATOC PET/MR imaging and radiomic parameters in predicting histopathological prognostic factors in patients with pancreatic neuroendocrine well-differentiated tumours. Eur J Nucl Med Mol Imaging 2022; 49:2352-2363. [DOI: 10.1007/s00259-022-05677-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/31/2021] [Indexed: 12/17/2022]
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10
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Marchegiani G, Crippa S, Perri G, Rancoita PMV, Caravati A, Belfiori G, Dall'Olio T, Aleotti F, Partelli S, Bassi C, Falconi M, Salvia R. ASO Visual Abstract: Surgery for IPMN of the Pancreas-Preoperative Factors Tipping the Scale of Decision-Making. Ann Surg Oncol 2022. [PMID: 35132488 DOI: 10.1245/s10434-022-11396-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G Marchegiani
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
| | - S Crippa
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Università Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Perri
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - P M V Rancoita
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - A Caravati
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - G Belfiori
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Università Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - T Dall'Olio
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - F Aleotti
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Università Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Partelli
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Università Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Bassi
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
| | - M Falconi
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Università Vita-Salute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy
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11
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Rossi RE, Milanetto AC, Andreasi V, Campana D, Coppa J, Nappo G, Rinzivillo M, Invernizzi P, Modica R, David A, Partelli S, Lamberti G, Mazzaferro V, Zerbi A, Panzuto F, Pasquali C, Falconi M, Massironi S. Risk of preoperative understaging of duodenal neuroendocrine neoplasms: a plea for caution in the treatment strategy. J Endocrinol Invest 2021; 44:2227-2234. [PMID: 33651317 DOI: 10.1007/s40618-021-01528-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/04/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Pretreatment staging is the milestone for planning either surgical or endoscopic treatment in duodenal neuroendocrine neoplasms (dNENs). Herein, a series of surgically treated dNEN patients was evaluated to assess the concordance between the pre- and postsurgical staging. METHODS Retrospective analysis of patients with a histologically confirmed diagnosis of dNENs, who underwent surgical resection observed at eight Italian tertiary referral centers. The presurgical TNM stage, based on the radiological and functional imaging, was compared with the pathological TNM stage, after surgery. RESULTS From 2000 to 2019, 109 patients were included. Sixty-six patients had G1, 26 a G2, 7 a G3 dNEN (Ki-67 not available in 10 patients). In 46/109 patients (42%) there was disagreement between the pre- and postsurgical staging, being it understaged in 42 patients (38%), overstaged in 4 (3%). As regards understaging, in 25 patients (22.9%), metastatic loco-regional nodes (N) resulted undetected at both radiological and functional imaging. Understaging due to the presence of distal micrometastases (M) was observed in 2 cases (1.8%). Underestimation of tumor extent (T) was observed in 12 patients (11%); in three cases the tumor was understaged both in T and N extent. CONCLUSIONS Conventional imaging has a poor detection rate for loco-regional nodes and micrometastases in the presurgical setting of the dNENs. These results represent important advice when local conservative approaches, such as endoscopy or local surgical excision are considered and it represents a strong recommendation to include endoscopic ultrasound in the preoperative tools for a more accurate local staging.
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Affiliation(s)
- R E Rossi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy.
| | - A C Milanetto
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - D Campana
- Department of Experimental, Diagnostic and Specialty Medicine, ENETS Center of Excellence, Bologna University, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - J Coppa
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy
| | - G Nappo
- Pancreatic Surgery, Humanitas Clinical, and Research Center-IRCCS, ENETS Center of Excellence, Humanitas University, Milan, Rozzano, Italy
| | - M Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - P Invernizzi
- Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano, Monza, Italy
| | - R Modica
- Division of Endocrinology, Department of Clinical Medicine and Surgery, ENETS Center of Excellence, University "Federico II" of Naples, Naples, Italy
| | - A David
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - G Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, ENETS Center of Excellence, Bologna University, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - V Mazzaferro
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Zerbi
- Pancreatic Surgery, Humanitas Clinical, and Research Center-IRCCS, ENETS Center of Excellence, Humanitas University, Milan, Rozzano, Italy
| | - F Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - C Pasquali
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padua, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - S Massironi
- Division of Gastroenterology, San Gerardo Hospital, Bicocca School of Medicine, University of Milano, Monza, Italy
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12
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Modlin IM, Kidd M, Falconi M, Filosso PL, Frilling A, Malczewska A, Toumpanakis C, Valk G, Pacak K, Bodei L, Öberg KE. A multigenomic liquid biopsy biomarker for neuroendocrine tumor disease outperforms CgA and has surgical and clinical utility. Ann Oncol 2021; 32:1425-1433. [PMID: 34390828 DOI: 10.1016/j.annonc.2021.08.1746] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Biomarkers are key tools in cancer management. In neuroendocrine tumors (NETs), Chromogranin A (CgA) was considered acceptable as a biomarker. We compared the clinical efficacy of a multigenomic blood biomarker (NETest) to CgA over a 5-year period. PATIENTS AND METHODS An observational, prospective, cross-sectional, multicenter, multinational, comparative cohort assessment. Cohort 1: NETest evaluation in NETs (n = 1684) and cancers, benign diseases, controls (n = 731). Cohort 2: (n = 1270): matched analysis of NETest/CgA in a sub-cohort of NETs (n = 922) versus other diseases and controls (n = 348). Disease status was assessed by response evaluation criteria in solid tumors (RECIST). NETest measurement: qPCR [upper limit of normal (ULN: 20)], CgA (EuroDiagnostica, ULN: 108 ng/ml). STATISTICS Mann-Whitney U-test, AUROC, chi-square and McNemar' test. RESULTS Cohort 1: NETest diagnostic accuracy was 91% (P < 0.0001) and identified pheochromocytomas (98%), small intestine (94%), pancreas (91%), lung (88%), gastric (80%) and appendix (79%). NETest reflected grading: G1: 40 ± 1, G2 (50 ± 1) and G3 (52 ± 1). Locoregional disease levels were lower (38 ± 1) than metastatic (52 ± 1, P < 0.0001). NETest accurately stratified RECIST-assessed disease extent: no disease (21 ± 1), stable (43 ± 2), progressive (62 ± 2) (P < 0.0001). NETest concordance with imaging (CT/MRI/68Ga-SSA-PET) 91%. Presurgery, all NETs (n = 153) were positive (100%). After palliative R1/R2 surgery (n = 51) all (100%) remained elevated. After curative R0-surgery (n = 102), NETest levels were normal in 81 (70%) with no recurrence at 2 years. In the 31 (30%) with elevated levels, 25 (81%) recurred within 2 years. Cohort #2: NETest diagnostic accuracy was 87% and CgA 54% (P < 0.0001). NETest was more accurate than CgA for grading (chi-square = 7.7, OR = 18.5) and metastatic identification (chi-square = 180, OR = 8.4). NETest identified progressive disease (95%) versus CgA (57%, P < 0.0001). Imaging concordance for NETest was 91% versus CgA (46%) (P < 0.0001). Recurrence prediction after surgery was NETest-positive in >94% versus CgA 11%. CONCLUSION NETest accurately diagnoses NETs and is an effective surrogate marker for imaging, grade, metastases and disease status compared to CgA. A multigenomic liquid biopsy is an accurate biomarker of NET disease.
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Affiliation(s)
- I M Modlin
- Department of Surgery, Yale University School of Medicine, New Haven, USA
| | - M Kidd
- Wren Laboratories, Branford, USA
| | - M Falconi
- Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P L Filosso
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - A Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Malczewska
- Department of Endocrinology and Neuroendocrine Tumours, Medical University of Silesia, Katowice, Poland
| | - C Toumpanakis
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
| | - G Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - K Pacak
- Medical Neuroendocrinology, National Institutes of Health, Bethesda, USA
| | - L Bodei
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - K E Öberg
- Department of Endocrine Oncology, University Hospital, Uppsala, Sweden.
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13
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Larcher A, Rowe I, Fallara G, Romani M, Doglioni C, Lucianò R, Casari G, Carerra P, Patricelli M, Falini A, Calloni S, De Cobelli F, Guazzarotti G, Mortini P, Capitanio J, Bandello F, Lattanzio R, Falconi M, Partelli S, Necchi A, Raggi D, Montorsi F, Capitanio U, Salonia A. External validation of the VHL alliance guidelines for VHL genetic testing in patients diagnosed with renal cell carcionoma. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Marchegiani G, Andrianello S, Crippa S, Pollini T, Belfiori G, Gozzini L, Cassalia F, Caravati A, Luchini C, Doglioni C, Bassi C, Falconi M, Salvia R. Actual malignancy risk of either operated or non-operated presumed mucinous cystic neoplasms of the pancreas under surveillance. Br J Surg 2021; 108:1097-1104. [PMID: 34059873 DOI: 10.1093/bjs/znab131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/25/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite the low malignant potential of pancreatic mucinous cystic neoplasms (MCNs), surgery is still performed. The aim of this pragmatic study was to assess the outcome of surgery and surveillance for patients presenting with a presumed MCN at the first evaluation. METHODS Data for patients with a presumed MCN observed from 2000 to 2016 at the Verona Pancreas Institute and San Raffaele Hospital were extracted from prospective databases. The endpoints were risk of malignancy at pathology and rate of misdiagnosis for the surgical series, expressed as an odds ratio (OR) with 95 per cent confidence interval, and disease-specific survival (DSS) for the surveillance cohort investigated by the Kaplan-Meier method. RESULTS A total of 424 patients were identified. In the surgical series (229 patients), the rate of misdiagnosis was 19.2 per cent. The rate of malignant MCNs was 10.9 per cent (25 patients). The overall rate of malignancy, including misdiagnoses, was 11.3 per cent (26 patients). Predictors of malignancy were mural nodules (OR 27.75, 95 per cent c.i. 4.44-173.61; P < 0.001), size at least 50 mm (OR 13.39, 2.01 to 89.47; P = 0.007), and carbohydrate antigen 19.9 level (OR 3.98, 1.19 to 13.30; P = 0.025). In the absence of mural nodules and enhancing walls, none of the resected presumed MCNs smaller than 50 mm were malignant. Only patients with high-risk stigmata undergoing surgery experienced a significantly reduced 5-year DSS compared with all other patients (88 versus 100 per cent; P = 0.031). CONCLUSION Presumed MCNs with mural nodules, enhancing walls or cysts of 50 mm or larger should be considered for upfront surgical resection owing to the high risk of malignancy. In the absence of these features, the incidence of malignancy is negligible, favouring surveillance in selected patients given the low risk of malignancy and the high rate of misdiagnosis. GRAPHICAL ABSTRACT Pancreatic mucinous cystic neoplasms (MCNs) are well known preneoplastic lesions. Despite the low rate of cancer, lesions without radiological features of malignancy are resected systematically. In the absence of mural nodules, enhancing walls or cyst size 50 mm or more, the incidence of malignancy is negligible. Given the high risk of misdiagnosis, in the absence of such radiological features, surveillance of presumed MCNs seems safer.
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Affiliation(s)
- G Marchegiani
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Andrianello
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - T Pollini
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - G Belfiori
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - L Gozzini
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - F Cassalia
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - A Caravati
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - C Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona Hospital Trust, Verona, Italy
| | - C Doglioni
- Department of Pathology, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - C Bassi
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - R Salvia
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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15
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Panzuto F, Maccauro M, Campana D, Faggiano A, Massironi S, Pusceddu S, Spada F, Ferone D, Modica R, Grana CM, Ferolla P, Rinzivillo M, Badalamenti G, Zatelli MC, Gelsomino F, De Carlo E, Bartolomei M, Brizzi MP, Cingarlini S, Versari A, Fanciulli G, Arvat E, Merola E, Cives M, Tafuto S, Baldari S, Falconi M. Impact of the SARS-CoV2 pandemic dissemination on the management of neuroendocrine neoplasia in Italy: a report from the Italian Association for Neuroendocrine Tumors (Itanet). J Endocrinol Invest 2021; 44:989-994. [PMID: 32803662 PMCID: PMC7429140 DOI: 10.1007/s40618-020-01393-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/09/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The organization of the healthcare system has significantly changed after the recent COVID-19 outbreak, with a negative impact on the management of oncological patients. The present survey reports data collected by the Italian Association for Neuroendocrine Tumors on the management of patients with neuroendocrine neoplasia (NEN) during the pandemic dissemination. METHODS A survey with 57 questions was sent to NEN-dedicated Italian centers regarding the management of patients in the period March 9, 2020, to May 9, 2020 RESULTS: The main modification in the centers' activity consisted of decreases in newly diagnosed NEN patients (- 76.8%), decreases in performed surgical procedures (- 58%), delays to starting peptide receptor radionuclide therapy (45.5%), postponed/canceled follow-up examinations (26%), and canceled multidisciplinary teams' activity (20.8%). A low proportion of centers (< 10%) reported having to withdraw systemic anti-tumor medical treatment due to concerns about the pandemic situation, whereas PRRT was withdrawn from no patients. CONCLUSION Although the COVID-19 outbreak induced the centers to reduce some important activities in the management of NEN patients, the Italian network was able to provide continuity in care without withdrawing anti-tumor treatment for the majority of patients.
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Affiliation(s)
- F Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - M Maccauro
- Nuclear Medicine Unit, ENETS Center of Excellence, IRRCS National Cancer Institute (INT), Milan, Italy
| | - D Campana
- Division of Oncology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Faggiano
- Endocrinology Unit, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - S Pusceddu
- Oncology Unit, ENETS Center of Excellence, IRRCS National Cancer Institute (INT), Milan, Italy
| | - F Spada
- Oncology Unit, ENETS Center of Excellence, European Cancer Institute (IEO), Milan, Italy
| | - D Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino; Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - R Modica
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - C M Grana
- Nuclear Medicine Division, IRCCS European Institute of Oncology, Milan, Italy
| | - P Ferolla
- Multidisciplinary Group for Diagnosis and Treatment of Neuroendocrine Tumors Umbria Regional Cancer Network, Perugia, Italy
| | - M Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - G Badalamenti
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - M C Zatelli
- Section of Endocrinology and Internal Medicine,, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Gelsomino
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - E De Carlo
- Department of Medicine, Internal Medicine III, University of Padova, Padua, Italy
| | - M Bartolomei
- Nuclear Medicine Department, Sant'Anna Hospital, Ferrara, Italy
| | - M P Brizzi
- Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - S Cingarlini
- Oncology Unit, ENETS Center of Excellence, University Hospital of Verona, Verona, Italy
| | - A Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - G Fanciulli
- NET Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari - Endocrine Unit, AOU Sassari, Sassari, Italy
| | - E Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Merola
- Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari di Trento (APSS), Trento, Italy
| | - M Cives
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - S Tafuto
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Napoli, Italy
| | - S Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - M Falconi
- Pancreatic Surgery, ENETS Center of Excellence, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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16
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Bezzi C, Mapelli P, Presotto L, Neri I, Scifo P, Savi A, Bettinardi V, Partelli S, Gianolli L, Falconi M, Picchio M. Radiomics in pancreatic neuroendocrine tumors: methodological issues and clinical significance. Eur J Nucl Med Mol Imaging 2021; 48:4002-4015. [PMID: 33835220 DOI: 10.1007/s00259-021-05338-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/24/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To present the state-of-art of radiomics in the context of pancreatic neuroendocrine tumors (PanNETs), with a focus on the methodological and technical approaches used, to support the search of guidelines for optimal applications. Furthermore, an up-to-date overview of the current clinical applications of radiomics in the field of PanNETs is provided. METHODS Original articles were searched on PubMed and Science Direct with specific keywords. Evaluations of the selected studies have been focused mainly on (i) the general radiomic workflow and the assessment of radiomic features robustness/reproducibility, as well as on the major clinical applications and investigations accomplished so far with radiomics in the field of PanNETs: (ii) grade prediction, (iii) differential diagnosis from other neoplasms, (iv) assessment of tumor behavior and aggressiveness, and (v) treatment response prediction. RESULTS Thirty-one articles involving PanNETs radiomic-related objectives were selected. In regard to the grade differentiation task, yielded AUCs are currently in the range of 0.7-0.9. For differential diagnosis, the majority of studies are still focused on the preliminary identification of discriminative radiomic features. Limited information is known on the prediction of tumors aggressiveness and of treatment response. CONCLUSIONS Radiomics is recently expanding in the setting of PanNETs. From the analysis of the published data, it is emerging how, prior to clinical application, further validations are necessary and methodological implementations require optimization. Nevertheless, this new discipline might have the potential in assisting the current urgent need of improving the management strategies in PanNETs patients.
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Affiliation(s)
- C Bezzi
- Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy
| | - P Mapelli
- Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy.,Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - L Presotto
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - I Neri
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - P Scifo
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - A Savi
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - V Bettinardi
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - S Partelli
- Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy.,Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - L Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - M Falconi
- Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy.,Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy
| | - M Picchio
- Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy. .,Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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17
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Ricci C, Partelli S, Landoni L, Rinzivillo M, Ingaldi C, Andreasi V, Nessi C, Muffatti F, Fontana M, Tamburrino D, Deiro G, Alberici L, Campana D, Panzuto F, Bassi C, Falconi M, Casadei R. Sporadic non-functioning pancreatic neuroendocrine tumours: multicentre analysis. Br J Surg 2021; 108:811-816. [PMID: 33724300 DOI: 10.1093/bjs/znaa141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/05/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Outcomes after surgery for sporadic pancreatic neuroendocrine neoplasms (Pan-NENs) were evaluated. METHODS This multicentre study included patients who underwent radical pancreatic resection for sporadic non-functioning Pan-NENs. In survival analysis, the risk of mortality in this cohort was analysed in relation to that of the matched healthy Italian population. Relative survival (RS) was calculated as the rate between observed and expected survival. Factors related to RS were investigated using multivariable modelling. RESULTS Among 964 patients who had pancreatic resection for sporadic non-functioning Pan-NENs, the overall RS rate was 91.8 (95 per cent c.i. 81.5 to 96.5) per cent. 2019 WHO grade (hazard ratio (HR) 5.75 (s.e. 4.63); P = 0.030) and European Neuroendocrine Tumour Society (ENETS) TNM stage (6.73 (3.61); P < 0.001) were independent predictors of RS. The probability of a normal lifespan for patients with G1, G2, G3 Pan-NENS, and pancreatic neuroendocrine carcinomas (Pan-NECs) was 96.7, 54.8, 0, and 0 per cent respectively. The probability of a normal lifespan was 99.8, 99.3, 79.8, and 46.8 per cent for those with stage I, II, III, and IV disease respectively. The overall disease-free RS rate was 73.6 (65.2 to 79.5) per cent. 2019 WHO grade (HR 2.10 (0.19); P < 0.001) and ENETS TNM stage (HR 2.50 (0.24); P < 0.001) significantly influenced disease-free RS. The probability of disease-free survival was 93.2, 84.9, 45.2, and 6.8 per cent for patients with stage I, II, III, and IV disease, and 91.9, 45.2, 9.4, and 0.7 per cent for those with G1, G2, G3 Pan-NENS, and Pan-NECs, respectively. CONCLUSION A surgical approach seems without benefit for Pan-NECs, and unnecessary for small G1 sporadic Pan-NENs. Surgery alone may be insufficient for stage III-IV and G3 Pan-NENs.
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Affiliation(s)
- C Ricci
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - L Landoni
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - M Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - C Ingaldi
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - C Nessi
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - F Muffatti
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - M Fontana
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - D Tamburrino
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy
| | - G Deiro
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - L Alberici
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - D Campana
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Oncology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - F Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - C Bassi
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - R Casadei
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
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18
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Massironi S, Campana D, Pusceddu S, Albertelli M, Faggiano A, Panzuto F, Smiroldo V, Andreasi V, Rossi RE, Maggio I, Torchio M, Dotto A, Modica R, Rinzivillo M, Carnaghi C, Partelli S, Fanetti I, Lamberti G, Corti F, Ferone D, Colao A, Annibale B, Invernizzi P, Falconi M. Second primary neoplasms in patients with lung and gastroenteropancreatic neuroendocrine neoplasms: Data from a retrospective multi-centric study. Dig Liver Dis 2021; 53:367-374. [PMID: 33645508 DOI: 10.1016/j.dld.2020.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with sporadic neuroendocrine neoplasms may exhibit a higher risk of a second primary tumor than the general population. AIM This study aimed to analyze the occurrence of second primary malignancies. METHODS A retrospective cohort of 2757 patients with sporadic lung and gastro-entero-pancreatic neuroendocrine neoplasms, managed at eight Italian tertiary referral Centers, was included. RESULTS Between 2000 and 2019, a second primary malignancy was observed in 271 (9.8%) neuroendocrine neoplasms patients with 32 developing a third tumor. There were 135 (49.8%) females and the median age was 64 years. The most frequent locations of the second tumors were breast (18.8%), prostate (12.5%), colon (9.6%), blood tumors (8.5%), and lung (7.7%). The second primary tumor was synchronous in 19.2% of cases, metachronous in 43.2%, and previous in 37.6%. As concerned the neuroendocrine neoplasms, the 5- and 10-year survival rates were 87.8% and 74.4%, respectively. PFS for patients with a second primary malignancy was shorter than for patients without a second primary malignancy. Death was mainly related to neuroendocrine neoplasms. CONCLUSION In NEN patients the prevalence of second primary malignancies was not negligible, suggesting a possible neoplastic susceptibility. Overall survival was not affected by the occurrence of a second primary malignancy.
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Affiliation(s)
- S Massironi
- Division Gastroenterology, San Gerardo Hospital, University of Milano - Bicocca School of Medicine, Via Pergolesi 33, 20900 Monza (MB), Italy.
| | - D Campana
- NET Team Bologna, ENETS Center of Excellence, "S. Orsola-Malpighi" University Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - S Pusceddu
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - M Albertelli
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, and Department of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy
| | - A Faggiano
- Department of Experimental Medicine, "Sapienza University of Rome" Rome, Italy
| | - F Panzuto
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - V Smiroldo
- UO Oncologia Medica ed Ematologia, Humanitas Cancer Center, ENETS Center of Excellence, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - V Andreasi
- Pancreatic Surgery Unit, ENETS Center of Excellence, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - R E Rossi
- Gastrointestinal and Hepato-Pancreatic Surgery and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute) and Department of Pathophysiology and Organ Transplant, Università degli Studi di Milano, Milan, Italy
| | - I Maggio
- NET Team Bologna, ENETS Center of Excellence, "S. Orsola-Malpighi" University Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - M Torchio
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - A Dotto
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, and Department of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy
| | - R Modica
- Department of Clinical Medicine and Surgery, ENETS Center of Excellence, Federico II University of Naples, Naples, Italy
| | - M Rinzivillo
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - C Carnaghi
- UO Oncologia Medica, Comprensorio Sanitario Bolzano, Bozen, Italy
| | - S Partelli
- Pancreatic Surgery Unit, ENETS Center of Excellence, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - I Fanetti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - G Lamberti
- NET Team Bologna, ENETS Center of Excellence, "S. Orsola-Malpighi" University Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy
| | - F Corti
- Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Tumori Milano, Milan, Italy
| | - D Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, and Department of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy
| | - A Colao
- Department of Clinical Medicine and Surgery, ENETS Center of Excellence, Federico II University of Naples, Naples, Italy
| | - B Annibale
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy; Department of Medical-Surgical Sciences and Translational Medicine, "La Sapienza" University of Rome, Rome, Italy
| | - P Invernizzi
- Division Gastroenterology, San Gerardo Hospital, University of Milano - Bicocca School of Medicine, Via Pergolesi 33, 20900 Monza (MB), Italy
| | - M Falconi
- Pancreatic Surgery Unit, ENETS Center of Excellence, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
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19
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Peretti U, Cavaliere A, Niger M, Tortora G, Di Marco MC, Rodriquenz MG, Centonze F, Rapposelli IG, Giordano G, De Vita F, Stuppia L, Avallone A, Ratti M, Paratore C, Forti LG, Orsi G, Valente MM, Gaule M, Macchini M, Carrera P, Calzavara S, Simbolo M, Melisi D, De Braud F, Salvatore L, De Lorenzo S, Chiarazzo C, Falconi M, Cascinu S, Milella M, Reni M. Germinal BRCA1-2 pathogenic variants (gBRCA1-2pv) and pancreatic cancer: epidemiology of an Italian patient cohort. ESMO Open 2021; 6:100032. [PMID: 33399070 PMCID: PMC7807989 DOI: 10.1016/j.esmoop.2020.100032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Germline BRCA1-2 pathogenic variants (gBRCApv) increase the risk of pancreatic cancer and predict for response to platinating agents and poly(ADP-ribose) polymerase inhibitors. Data on worldwide gBRCApv incidence among pancreatic ductal adenocarcinoma (PDAC) patients are sparse and describe a remarkable geographic heterogeneity. The aim of this study is to analyze the epidemiology of gBRCApv in Italian patients. MATERIALS AND METHODS Patients of any age with pancreatic adenocarcinoma, screened within 3 months from diagnosis for gBRCApv in Italian oncologic centers systematically performing tests without any selection. For the purposes of our analysis, breast, ovarian, pancreas, and prostate cancer in a patient's family history was considered as potentially BRCA-associated. Patients or disease characteristics were examined using the χ2 test or Fisher's exact test for qualitative variables and the Student's t-test or Mann-Whitney test for continuous variables, as appropriate. RESULTS Between June 2015 and May 2020, 939 patients were tested by 14 Italian centers; 492 (52%) males, median age 62 years (range 28-87), 569 (61%) metastatic, 273 (29%) with a family history of potentially BRCA-associated cancers. gBRCA1-2pv were found in 76 patients (8.1%; 9.1% in metastatic; 6.4% in non-metastatic). The gBRCA2/gBRCA1 ratio was 5.4 : 1. Patients with gBRCApv were younger compared with wild-type (59 versus 62 years, P = 0.01). The gBRCApv rate was 17.1% among patients <40 years old, 10.4% among patients 41-50 years old, 9.2% among patients 51-60 years old, 6.7% among patients aged 61-70 years, and 6.2% among patients >70 years old (none out of 94 patients >73 years old). gBRCApv frequency in 845 patients <74 years old was 9%. Patients with/without a family history of potentially BRCA-associated tumors had 14%/6% mutations. CONCLUSION Based on our findings of a gBRCApv incidence higher than expected in a real-life series of Italian patients with incident PDAC, we recommend screening all PDAC patients <74 years old, regardless of family history and stage, due to the therapeutic implications and cancer risk prevention in patients' relatives.
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Affiliation(s)
- U Peretti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - A Cavaliere
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Tortora
- Department of Medicine, Section of Medical Oncology, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - M C Di Marco
- Medical Oncology Division, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy; Medical Oncology Division, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M G Rodriquenz
- Oncology Unit, foundation IRCCS Casa Sollievo della sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - F Centonze
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - I G Rapposelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G Giordano
- Department of Medical Oncology, Policlinico Riuniti, Azienda Ospedaliero Universitarià, Foggia, Italy
| | - F De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, 'Luigi Vanvitelli' University of Campania, Naples, Italy
| | - L Stuppia
- Medical Genetics, Department of Psychological, Health and Territorial Sciences Center for Advanced Sciences and Technology G. d'Annunzio University Chieti-Pescara Italy, Chieti, Italy
| | - A Avallone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori- IRCCS-Fondazione G. Pascale, Naples, Italy
| | - M Ratti
- Department of Oncology, Medical Department, ASST di Cremona, Ospedale di Cremona, Cremona, Italy
| | - C Paratore
- Chiara Paratore, University of Turin, Ordine Mauriziano Hospital, Largo Filippo Turati, Turin, Italy
| | - L G Forti
- SCDU Oncologia, AOU Maggiore della Carità, Novara, Italy
| | - G Orsi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M M Valente
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M Gaule
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Macchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - P Carrera
- Clinical Genomics - Molecular Genetics Service, Genomics for Diagnosis of Human Diseases, San Raffaele Hospital, Milan, Italy
| | - S Calzavara
- Clinical Genomics - Molecular Genetics Service, Genomics for Diagnosis of Human Diseases, San Raffaele Hospital, Milan, Italy
| | - M Simbolo
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - D Melisi
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - F De Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - L Salvatore
- Department of Medicine, Section of Medical Oncology, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - S De Lorenzo
- Medical Oncology Division, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - C Chiarazzo
- Oncology Unit, foundation IRCCS Casa Sollievo della sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - M Falconi
- Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy; Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy
| | - M Milella
- Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy
| | - M Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pancreas Translational & Clinical Research Center, 'Vita-Salute' University, San Raffaele Scientific Institute, Milan, Italy.
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20
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Balduzzi A, van Hilst J, Korrel M, Lof S, Al-Sarireh B, Alseidi A, Berrevoet F, Björnsson B, van den Boezem P, Boggi U, Busch OR, Butturini G, Casadei R, van Dam R, Dokmak S, Edwin B, Sahakyan MA, Ercolani G, Fabre JM, Falconi M, Forgione A, Gayet B, Gomez D, Koerkamp BG, Hackert T, Keck T, Khatkov I, Krautz C, Marudanayagam R, Menon K, Pietrabissa A, Poves I, Cunha AS, Salvia R, Sánchez-Cabús S, Soonawalla Z, Hilal MA, Besselink MG. Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study. Surg Endosc 2021; 35:6949-6959. [PMID: 33398565 DOI: 10.1007/s00464-020-08206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. METHODS An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. RESULTS Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. CONCLUSION The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.
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Affiliation(s)
- A Balduzzi
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. .,General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - J van Hilst
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - M Korrel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - A Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - B Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - P van den Boezem
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - U Boggi
- Department of Surgery, Universitá di Pisa, Pisa, Italy
| | - O R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - G Butturini
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - R Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - R van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S Dokmak
- Department of Surgery, Hospital of Beaujon, Clichy, France
| | - B Edwin
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - M A Sahakyan
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - G Ercolani
- Department of General Surgery and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna Forlì, Forlì, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - J M Fabre
- Department of Surgery, Hopital Saint Eloi, Montpellier, France
| | - M Falconi
- San Raffaele Hospital Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Università Vita-Salute, Milan, Italy
| | - A Forgione
- Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - B Gayet
- Department of Surgery, Institut Mutualiste Montsouris, Paris, France
| | - D Gomez
- Department of Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - T Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Keck
- Department of Surgery, University Hospital Schleswig-Holstein UKSH Campus Lübeck, Lübeck, Germany
| | - I Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - C Krautz
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R Marudanayagam
- Department of Surgery, University Hospital Birmingham, Birmingham, UK
| | - K Menon
- Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - A Pietrabissa
- Department of Surgery, University Hospital Pavia, Pavia, Italy
| | - I Poves
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - A Sa Cunha
- Department of Surgery, Hôpital Paul-Brousse, Villejuif, France
| | - R Salvia
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Sánchez-Cabús
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Z Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - M Abu Hilal
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. .,HPB and Minimally Invasive Surgery, Southampton University, Southampton, UK.
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.
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21
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Gaziano R, Campione E, Iacovelli F, Pistoia ES, Marino D, Milani M, Di Francesco P, Pica F, Bianchi L, Orlandi A, Marsico S, Falconi M, Aquaro S. Antimicrobial properties of the medicinal plant Cardiospermum halicacabum L: new evidence and future perspectives. Eur Rev Med Pharmacol Sci 2020; 23:7135-7143. [PMID: 31486516 DOI: 10.26355/eurrev_201908_18759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The emergence and rapid spread of multidrug-resistance in human pathogenic microorganisms urgently require the development of novel therapeutic strategies for the treatment of infectious diseases. From this perspective, the antimicrobial properties of the natural plant-derived products may represent an important alternative therapeutic option to synthetic drugs. Among medicinal plants, the Cardiospermum halicacabum L. (C. halicacabum), belonging to Sapindaceae family, could be a very promising candidate for its antimicrobial activity against a wide range of microorganisms, including both Gram-positive and Gram-negative bacteria, as well as fungal pathogens. Although the antimicrobial properties of C. halicacabum have been intensively studied, the mechanism/s by which it exerts the inhibitory activity towards the pathogenic microbes have not yet been completely understood. This review focuses on the main antimicrobial activities displayed in vitro by the plant extract, with particular attention on our recent advances. We demonstrated that C. halicacabum is able to exert in vitro a dose-dependent fungistatic effect against Trychophyton rubrum (T. rubrum) through molecular interaction with the fungal heat shock protein (Hsp)-90 chaperone. These findings are supported by a growing body of research indicating the crucial role played by the Hsp90 in the virulence of the pathogenic microorganisms, including fungal pathogens. The possible future use of C. halicacabum for treating a wide range of infectious diseases is also discussed.
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Affiliation(s)
- R Gaziano
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
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22
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Pecorelli N, Pagnanelli M, Belfiori G, Delpini R, Cinelli L, Tamburrino D, Crippa S, Partelli S, Castoldi R, Reni M, Falconi M, Balzano G. Postoperative outcomes and functional recovery after neoadjuvant chemotherapy for pancreatic cancer: A propensity score-matched study. European Journal of Surgical Oncology 2020. [DOI: 10.1016/j.ejso.2020.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Della-Torre E, Mancuso G, Lanzillotta M, Ramirez GA, Arcidiacono PG, Capurso G, Falconi M, Dagna L. Urgent manifestations of immunoglobulin G 4-related disease. Scand J Rheumatol 2020; 50:48-51. [PMID: 32692264 DOI: 10.1080/03009742.2020.1771763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Immunoglobulin G4-related disease (IgG4-RD) is considered a chronic condition with insidious presentation, but clinical experience suggests that disease onset prompts admission to the emergency department (ED) in a sizeable proportion of patients. We assessed the prevalence of acute manifestations associated with IgG4-RD onset requiring referral to the ED. Method: We revised our database and identified patients admitted to the ED because of symptoms latterly attributed to IgG4-RD onset (Group 1) and those who were referred to our outpatient clinic without previous urgent manifestations (Group 2). Acute manifestations were clustered based on the anatomical region affected by IgG4-RD. Epidemiological, clinical, and serological features of Groups 1 and 2 were compared. Results: The study included 141 patients with IgG4-RD. Of these, 76 (54%) presented to the ED at disease onset. The most common clinical manifestations requiring admission to the ED were jaundice (53%), abdominal pain (41%), and fever (10%). Gastrointestinal involvement was the most frequent cause of referral to the ED (71% of cases), followed by involvement of the retroperitoneum (14.5%) and the nervous system (6.6%). Pancreatobiliary involvement was significantly more frequent in Group 1 than in Group 2. Head and neck, and salivary and lacrimal gland involvement was more frequent in Group 2 than in Group 1. The diagnostic delay was significantly shorter in Group 1 than in Group 2. Conclusion: Clinical manifestations associated with IgG4-RD onset require referral to the ED in most cases. This finding contrasts with the general view of IgG4-RD as a condition with non-acute presentation.
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Affiliation(s)
- E Della-Torre
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - G Mancuso
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - M Lanzillotta
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - G A Ramirez
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - P G Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - G Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - M Falconi
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - L Dagna
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University , Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan, Italy
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24
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Pavel M, Öberg K, Falconi M, Krenning EP, Sundin A, Perren A, Berruti A. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31:844-860. [PMID: 32272208 DOI: 10.1016/j.annonc.2020.03.304] [Citation(s) in RCA: 474] [Impact Index Per Article: 118.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- M Pavel
- Department of Medicine 1, University Hospital Erlangen, Erlangen, Germany
| | - K Öberg
- Department of Endocrine Oncology, Uppsala University, Uppsala, Sweden
| | - M Falconi
- Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E P Krenning
- Cyclotron Rotterdam BV, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - A Sundin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - A Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
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25
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Balzano G, Guarneri G, Pecorelli N, Paiella S, Rancoita PMV, Bassi C, Falconi M. Modelling centralization of pancreatic surgery in a nationwide analysis. Br J Surg 2020; 107:1510-1519. [DOI: 10.1002/bjs.11716] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/26/2020] [Accepted: 04/29/2020] [Indexed: 12/31/2022]
Abstract
Abstract
Background
The benefits of centralization of pancreatic surgery have been documented, but policy differs between countries. This study aimed to model various centralization criteria for their effect on a nationwide cohort.
Methods
Data on all pancreatic resections performed between 2014 and 2016 were obtained from the Italian Ministry of Health. Mortality was assessed for different hospital volume categories and for each individual facility. Observed mortality and risk-standardized mortality rate (RSMR) were calculated. Various models of centralization were tested by applying volume criteria alone or in combination with mortality thresholds.
Results
A total of 395 hospitals performed 12 662 resections; 305 hospitals were in the very low-volume category (mean 2·6 resections per year). The nationwide mortality rate was 6·2 per cent, increasing progressively from 3·1 per cent in very high-volume to 10·6 per cent in very low-volume hospitals. For the purposes of centralization, applying a minimum volume threshold of at least ten resections per year would lead to selection of 92 facilities, with an overall mortality rate of 5·3 per cent. However, the mortality rate would exceed 5 per cent in 48 hospitals and be greater than 10 per cent in 17. If the minimum volume were 25 resections per year, the overall mortality rate would be 4·7 per cent in 38 facilities, but still over 5 per cent in 17 centres and more than 10 per cent in five. The combination of a volume requirement (at least 10 resections per year) with a mortality threshold (maximum RSMR 5 or 10 per cent) would allow exclusion of facilities with unacceptable results, yielding a lower overall mortality rate (2·7 per cent in 45 hospitals or 4·2 per cent in 76 respectively).
Conclusion
The best performance model for centralization involved a threshold for volume combined with a mortality threshold.
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Affiliation(s)
- G Balzano
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - G Guarneri
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - N Pecorelli
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - S Paiella
- General and Pancreatic Surgery Unit — Pancreas Institute, University of Verona, Verona, Italy
| | - P M V Rancoita
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - C Bassi
- General and Pancreatic Surgery Unit — Pancreas Institute, University of Verona, Verona, Italy
| | - M Falconi
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
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26
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Mapelli P, Fallanca F, Franchini A, Albarello L, Vanoli EG, Partelli S, Muffatti F, Gianolli L, Falconi M, Picchio M. Pancreatic metastases from primary ileal NET only detected by 68Ga-DOTATOC PET/CT. Eur J Nucl Med Mol Imaging 2020; 47:2713-2714. [PMID: 32170346 DOI: 10.1007/s00259-020-04719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/05/2020] [Indexed: 11/25/2022]
Affiliation(s)
- P Mapelli
- Vita-Salute San Raffaele University, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Fallanca
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Franchini
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- University of Milano-Bicocca, Milan, Italy
| | - L Albarello
- Pathology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E G Vanoli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Partelli
- Vita-Salute San Raffaele University, Milan, Italy
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Muffatti
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Falconi
- Vita-Salute San Raffaele University, Milan, Italy
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Picchio
- Vita-Salute San Raffaele University, Milan, Italy.
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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27
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Mapelli P, Ironi G, Fallanca F, Partelli S, Muffatti F, Andreasi V, Gianolli L, Falconi M, De Cobelli F, Picchio M. 68Ga-DOTA-peptides PET/MRI in pancreatico-duodenal neuroendocrine tumours: a flash pictorial essay on assets and lacks. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00341-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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28
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Merlo B, Teti G, Lanci A, Burk J, Mazzotti E, Falconi M, Iacono E. Comparison between adult and foetal adnexa derived equine post-natal mesenchymal stem cells. BMC Vet Res 2019; 15:277. [PMID: 31375144 PMCID: PMC6679462 DOI: 10.1186/s12917-019-2023-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 07/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Little is known about the differences among adult and foetal equine mesenchymal stem cells (MSCs), and no data exist about their comparative ultrastructural morphology. The aim of this study was to describe and compare characteristics, immune properties, and ultrastructural morphology of equine adult (bone marrow: BM, and adipose tissue: AT) and foetal adnexa derived (umbilical cord blood: UCB, and Wharton’s jelly: WJ) MSCs. Results No differences were observed in proliferation during the first 3 passages. While migration ability was similar among cells, foetal MSCs showed a higher adhesion ability, forming smaller spheroids after hanging drop culture (P < 0.05). All MSCs differentiated toward adipogenic, chondrogenic and osteogenic lineages, only tenogenic differentiation was less evident for WJ-MSCs. Data obtained by PCR confirmed MHC1 expression and lack of MHC2 expression in all four cell types. Foetal adnexa MSCs were positive for genes specific for anti-inflammatory and angiogenic factors (IL6, IL8, ILβ1) and WJ-MSCs were the only positive for OCT4 pluripotency gene. At immunofluorescence all cells expressed typical mesenchymal markers (α-SMA, N-cadherin), except for BM-MSCs, which did not express N-cadherin. By transmission electron microscopy, it was observed that WJ-MSCs had a higher (P < 0.05) number of microvesicles compared to adult MSCs, and UCB-MSCs showed more microvesicles than BM-MSCs (P < 0.05). AT-MSCs had a lower number of mitochondria than WJ-MSCs (P < 0.05), and mitochondrial area was higher for WJ-MSCs compared to UCB and AT-MSCs (P < 0.05). Conclusions Results demonstrate that MSCs from adult and foetal tissues have different characteristics, and foetal MSCs, particularly WJ derived ones, seem to have some charactestics that warrant further investigation into potential advantages for clinical application.
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Affiliation(s)
- B Merlo
- Department of Veterinary Medical Sciences, University of Bologna, via Tolara di Sopra 50, 40064, Ozzano Emilia, BO, Italy.,Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy
| | - G Teti
- Department for Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - A Lanci
- Department of Veterinary Medical Sciences, University of Bologna, via Tolara di Sopra 50, 40064, Ozzano Emilia, BO, Italy
| | - J Burk
- Saxon Incubator for Clinical Translation, University of Leipzig, Leipzig, Germany.,Equine Clinic (Surgery), Justus Liebig University Giessen, Giessen, Germany
| | - E Mazzotti
- Department of Comparative Biomedical Sciences, University of Teramo, Teramo, Italy
| | - M Falconi
- Department for Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - E Iacono
- Department of Veterinary Medical Sciences, University of Bologna, via Tolara di Sopra 50, 40064, Ozzano Emilia, BO, Italy. .,Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy.
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29
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Pergolini I, Crippa S, Pagnanelli M, Belfiori G, Pucci A, Partelli S, Rubini C, Castelli P, Zamboni G, Falconi M. Prognostic impact of Ki-67 proliferative index in resectable pancreatic ductal adenocarcinoma. BJS Open 2019; 3:646-655. [PMID: 31592095 PMCID: PMC6773637 DOI: 10.1002/bjs5.50175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is an aggressive disease characterized by complex biological features and poor prognosis. A prognostic stratification of PDAC would help to improve patient management. The aim of this study was to analyse the expression of Ki‐67 in relation to prognosis in a cohort of patients with PDAC who had surgical treatment. Methods Patients who had pancreatic resection between August 2010 and October 2014 for PDAC at two Italian centres were reviewed retrospectively. Patients with metastatic or locally advanced disease, those who received neoadjuvant chemotherapy, patients with PDAC arising from intraductal papillary mucinous neoplasm and those with missing data were excluded. Clinical and pathological data were retrieved and analysed. Ki‐67 expression was evaluated using immunohistochemistry and patients were stratified into three subgroups. Survival analyses were performed for disease‐free (DFS) and disease‐specific (DSS) survival outcomes according to Ki‐67 expression and tumour grading. Results A total of 170 patients met the selection criteria. Ki‐67 expression of 10 per cent or less, 11–50 per cent and more than 50 per cent significantly correlated with DFS and DSS outcomes (P = 0·016 and P = 0·002 respectively). Ki‐67 index was an independent predictor of poor DFS (hazard ratio (HR) 0·52, 95 per cent c.i. 0·29 to 0·91; P = 0·022) and DSS (HR 0·53, 0·31 to 0·91; P = 0·022). Moreover, Ki‐67 index correlated strongly with tumour grade (P < 0·001). Patients with PDAC classified as a G3 tumour with a Ki‐67 index above 50 per cent had poor survival outcomes compared with other patients (P < 0·001 for both DFS and DSS). Conclusion Ki‐67 index could be of use in predicting the survival of patients with PDAC. Further investigation in larger cohorts is needed to validate these results.
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Affiliation(s)
- I Pergolini
- Department of Surgery Università Politecnica delle Marche Ospedali Riuniti, Ancona Italy
| | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, Università Vita e Salute IRCCS San Raffaele Scientific Institute Milan Italy
| | - M Pagnanelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, Università Vita e Salute IRCCS San Raffaele Scientific Institute Milan Italy
| | - G Belfiori
- Department of Surgery Università Politecnica delle Marche Ospedali Riuniti, Ancona Italy
| | - A Pucci
- Department of Surgery Università Politecnica delle Marche Ospedali Riuniti, Ancona Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, Università Vita e Salute IRCCS San Raffaele Scientific Institute Milan Italy
| | - C Rubini
- Department of Pathology Università Politecnica delle Marche Ospedali Riuniti, Ancona Italy
| | - P Castelli
- Department of Pathology Ospedale Sacro Cuore - Don Calabria Negrar Italy
| | - G Zamboni
- Department of Pathology Ospedale Sacro Cuore - Don Calabria Negrar Italy.,Department of Pathology Università di Verona Verona Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, Università Vita e Salute IRCCS San Raffaele Scientific Institute Milan Italy
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30
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Mazzotti MC, Fais P, Palazzo C, Fersini F, Ruggeri A, Falconi M, Pelotti S, Teti G. Determining the time of death by morphological and immunohistochemical evaluation of collagen fibers in postmortem gingival tissues. Leg Med (Tokyo) 2019; 39:1-8. [PMID: 31078972 DOI: 10.1016/j.legalmed.2019.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/27/2019] [Accepted: 05/05/2019] [Indexed: 12/23/2022]
Abstract
The estimation of the post mortem interval (PMI) is still one of the most challenging variables to determine and the different approaches currently used in its estimation generally yield to large post mortem windows. In the present study we combined morphological and immunohistochemical analysis in order to reach a more detailed knowledge on tissue organization and degradation after death. Ultrastructural cellular changes and the extracellular matrix of gingival tissues, collected at different post mortem intervals, were observed by a Transmission Electron Microscopy (TEM), in combination with the immunohistochemical detection of extracellular matrix proteins (i.e. collagen type I and collagen type III) as potential post mortem biochemical markers. The final goal was to find a correlation between morphological modifications, biomarkers expression and the time of death. Samples of gingival tissues obtained from 10 cadavers at different post mortem intervals (short post mortem interval, 1-3 days; mid post mortem interval, 4-6 days; long post mortem interval, 7-9 days) were processed for light microscopy and TEM and they were also immunostained with anti-collagen type I and type III antibodies. Results showed gradual degradation of extracellular matrix in the suboral connective tissue in relation to the different time of death. Moreover PMI was related to an increase of nuclear chromatin condensation and cytoplasmic vacuolization both in epithelial and connective tissues. In conclusion, in addition to traditional forensic approaches to estimate PMI, the combined analyses of cellular morphology, ultrastructure and immunohistochemical expression of collagen proteins allow to better infer the PMI.
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Affiliation(s)
- M C Mazzotti
- Department of Medical and Surgery Sciences, University di Bologna, Bologna, Italy.
| | - P Fais
- Department of Medical and Surgery Sciences, University di Bologna, Bologna, Italy
| | - C Palazzo
- Department of Medical and Surgery Sciences, University di Bologna, Bologna, Italy
| | - F Fersini
- Department of Medical and Surgery Sciences, University di Bologna, Bologna, Italy
| | - A Ruggeri
- Department of Biomedical and Neuromotor Sciences, University di Bologna, Bologna, Italy
| | - M Falconi
- Department of Biomedical and Neuromotor Sciences, University di Bologna, Bologna, Italy
| | - S Pelotti
- Department of Medical and Surgery Sciences, University di Bologna, Bologna, Italy
| | - G Teti
- Department of Biomedical and Neuromotor Sciences, University di Bologna, Bologna, Italy
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31
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Falconi M. SP-0657 Against the motion: resectable pancreatic cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Sini C, Mori M, Benedetti G, Panzeri M, Barbera M, Partelli S, Falconi M, De Cobelli F, Fiorino C. 297. Radiomic CT features of pancreatic neuroendocrine tumors are robust against inter-observer delineation uncertainty. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Bouvier C, Caplin M, Conroy S, Davies P, Dureja S, Falconi M, Ferolla P, Fisher G, Goldstein G, Hicks R, Hollander R, Kolarova T, Lawrence B, Leyden S, Majima Y, Metz D, O’Toole D, Ruszniewski P, Wiedenmann B. Unmet needs in the management of neuroendocrine tumours (NETs): A global survey of patients, patient advocates and healthcare professionals. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Genç CG, Falconi M, Partelli S, Muffatti F, van Eeden S, Doglioni C, Klümpen HJ, van Eijck CHJ, Nieveen van Dijkum EJM. Recurrence of Pancreatic Neuroendocrine Tumors and Survival Predicted by Ki67. Ann Surg Oncol 2018; 25:2467-2474. [PMID: 29789972 PMCID: PMC6028862 DOI: 10.1245/s10434-018-6518-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Indexed: 12/24/2022]
Abstract
Background Despite evidence of different malignant potentials, postoperative follow-up assessment is similar for G1 and G2 pancreatic neuroendocrine tumors (panNETs) and adjuvant treatment currently is not indicated. This study investigated the role of Ki67 with regard to recurrence and survival after curative resection of panNET. Methods Patients with resected non-functioning panNET diagnosed between 1992 and 2016 from three institutions were retrospectively analyzed. Patients who had G1 or G2 tumor without distant metastases or hereditary syndromes were included in the study. The patients were re-categorized into Ki67 0–5 and Ki67 6–20%. Cox regression analysis with log-rank testing for recurrence and survival was performed. Results The study enrolled 241 patients (86%) with Ki67 0–5% and 39 patients (14%) with Ki67 6–20%. Recurrence was seen in 34 patients (14%) with Ki67 0–5% after a median period of 34 months and in 16 patients (41%) with Ki67 6–20% after a median period of 16 months (p < 0.001). The 5-year recurrence-free and 10-year disease-specific survival periods were respectively 90 and 91% for Ki67 0–5% and respectively 55 and 26% for Ki67 6–20% (p < 0.001). The overall survival period after recurrence was 44.9 months, which was comparable between the two groups (p = 0.283). In addition to a Ki67 rate higher than 5%, tumor larger than 4 cm and lymph node metastases were independently associated with recurrence. Conclusions Patients at high risk for recurrence after curative resection of G1 or G2 panNET can be identified by a Ki67 rate higher than 5%. These patients should be more closely monitored postoperatively to detect recurrence early and might benefit from adjuvant treatment. A clear postoperative follow-up regimen is proposed.
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Affiliation(s)
- C G Genç
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Research Institute, Scientific Institute, San Raffaele Hospital, University Vita e Salute, Milan, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Research Institute, Scientific Institute, San Raffaele Hospital, University Vita e Salute, Milan, Italy
| | - F Muffatti
- Pancreatic Surgery Unit, Pancreas Translational and Research Institute, Scientific Institute, San Raffaele Hospital, University Vita e Salute, Milan, Italy
| | - S van Eeden
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - C Doglioni
- Department of Pathology, Scientific Institute, San Raffaele Hospital, University Vita e Salute, Milan, Italy
| | - H J Klümpen
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - C H J van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Balzano G, Zanon S, Castoldi R, Aleotti F, Zerbi A, Falconi M, Andreasi V, Gianni L, Nicoletti R, Reni M. A randomized phase II trial on neoadjuvant chemotherapy in resectable pancreatic adenocarcinoma. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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36
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Vanella G, Crippa S, Archibugi L, Arcidiacono PG, Delle Fave G, Falconi M, Capurso G. Meta-analysis of mortality in patients with high-risk intraductal papillary mucinous neoplasms under observation. Br J Surg 2018; 105:328-338. [PMID: 29405253 DOI: 10.1002/bjs.10768] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/25/2017] [Accepted: 10/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although consensus guidelines suggest that patients with high-risk intraductal papillary mucinous neoplasms (IPMNs) should have surgery, a non-operative strategy is often selected in patients who are poor surgical candidates. The aim was to determine the risk of disease-related death from IPMN in patients with worrisome features or high-risk stigmata who were kept under observation. METHODS A PubMed literature search was undertaken of articles published from August 1992 to June 2016 (updated October 2017). The methodology was developed from PRISMA and MOOSE checklists. Incidence proportions and rates of overall and IPMN-related deaths were calculated, with subgroup analyses for main-duct/mixed-type and branch-duct IPMNs. Quality of the studies, publication bias and heterogeneity were explored. RESULTS Six studies reported data on overall mortality and eight described disease-specific mortality for 556 patients during follow-up ranging from 24·9 to 60·0 months. Pooled rates of overall and IPMN-related mortality were 30·9 (95 per cent c.i. 19·6 to 45·1) and 11·6 (6·0 to 21·2) per cent respectively. The pooled incidence rate for overall mortality was substantially higher than that for IPMN-related mortality: 78 (95 per cent c.i. 44 to 111) and 23 (9 to 37) per 1000 patient-years respectively. The pooled incidence rate for disease-specific mortality was considerably lower for branch-duct than for main-duct or mixed-type IPMNs: 5 (0 to 10) and 32 (12 to 52) per 1000 patient-years respectively. CONCLUSION In patients unfit for surgery, IPMN-related mortality among patients with worrisome features and high-risk stigmata is low, and the risk of death from other causes much higher.
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Affiliation(s)
- G Vanella
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - L Archibugi
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - P G Arcidiacono
- Pancreato-Biliary Endoscopy Division and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy
| | - G Delle Fave
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - G Capurso
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Ferese, Albano V, Falconi M. Structural modeling of altered CLCN1 conformation following a novel mutation in a patient affected by autosomal dominant myotonia congenita (Thomsen disease). Arch Ital Biol 2018; 155:118-130. [DOI: 10.12871/000398292017410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Reni M, Zanon S, Balzano G, Nobile S, Pircher CC, Chiaravalli M, Passoni P, Arcidiacono PG, Nicoletti R, Crippa S, Slim N, Doglioni C, Falconi M, Gianni L. Selecting patients for resection after primary chemotherapy for non-metastatic pancreatic adenocarcinoma. Ann Oncol 2017; 28:2786-2792. [PMID: 28945895 DOI: 10.1093/annonc/mdx495] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with borderline (BL) or locally advanced (LA) pancreatic adenocarcinoma are usually treated with primary chemotherapy (CT), followed by resection when feasible. Scanty data are available about the criteria to candidate patients to resection after CT. PATIENTS AND METHODS Between 2002 and 2016 overall 223 patients diagnosed with BL or LA pancreatic adenocarcinoma were primarily treated with Gemcitabine combination (4-drugs or nab-paclitaxel-gemcitabine) for 3-6 months followed by surgery and/or chemoradiation. Resection was carried out when radical resection could be predicted by imaging studies and intraoperative findings. The prognostic value of both pre-treatment factors and treatment response was retrospectively evaluated, searching for criteria that could improve the selection of patients for surgery. RESULTS Median survival (MS) for the whole population was 18.3 months. Surgical resection was carried out in 61 patients; MS in resected patients was significantly longer (30.0 months) as compared with 162 non-resected patients (16.5 months) (P < 0.00001). According to response criteria, 48% had a radiological partial response, 47% a stable disease and 5% a disease progression); CA19.9 response (reduction >50%) was obtained in 77.8% of patients. Among resected patients, neither pre-treatment factors, including BL/LA distinction, nor radiological response, were able to prognosticate survival differences. Survival of resected patients having no CA19.9 response was significantly lower as compared with responders (MS 15.0 versus 31.5 months, P = 0.04), and was similar to non-responders patients that did not undergo resection (MS 10.9 months, P= 0.25). Multivariate analysis carried out on the overall population, showed that Karnofsky performance status, T3-T4 status, resection and CA19.9 response were independent prognostic factors, while radiological response, BL/LA distinction and baseline CA19.9 had not significant influence on survival. CONCLUSIONS CA19.9 response may allow a better selection of patients who will benefit from resection after primary CT for BL or LA pancreatic adenocarcinoma.
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Affiliation(s)
| | | | - G Balzano
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center
| | - S Nobile
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center
| | | | | | | | - P G Arcidiacono
- Department of Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS
| | | | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center
| | - N Slim
- Department of Radiotherapy
| | - C Doglioni
- Department of Pathology, Pancreas Translational & Clinical Research Center, IRCCS Ospedale San Raffaele, Milan; Department of Vita-Salute San Raffaele University, Milan, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center; Department of Vita-Salute San Raffaele University, Milan, Italy
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Reni M, Zanon S, Balzano G, Castoldi R, Zerbi A, Tronconi M, Pinelli D, Mosconi S, Doglioni C, Galli F, Falconi M, Gianni L. Randomized phase 2 trial of peri- or post-operative chemotherapy in resectable pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Zanon S, Pircher C, Chiaravalle M, Macchini M, Peretti U, Balzano G, Passoni P, Nicoletti R, Arcidiacono P, Pepe G, Doglioni C, Romi S, Gritti E, Falconi M, Gianni L, Reni M. Randomized phase 2 trial of nab-paclitaxel plus gemcitabine, ± capecitabine, cisplatin (paxg regimen) in metastatic pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx425.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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41
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Reni M, Zanon S, Pircher C, Chiaravalli M, Macchini M, Peretti U, Mazza E, Balzano G, Passoni P, Nicoletti R, Arcidiacono P, Pepe G, Doglioni C, Romi S, Ceraulo D, Falconi M, Gianni L. Randomized phase 2 trial of nab-paclitaxel plus gemcitabine, ± capecitabine, cisplatin (PAXG regimen) in metastatic pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Reni M, Zanon S, Balzano G, Castoldi R, Zerbi A, Tronconi M, Pinelli D, Mosconi S, Doglioni C, Falconi M, Gianni L. Randomized phase 2 trial of peri- or post-operative chemotherapy in resectable pancreatic adenocarcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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43
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Dozza B, Lesci IG, Duchi S, Della Bella E, Martini L, Salamanna F, Falconi M, Cinotti S, Fini M, Lucarelli E, Donati D. When size matters: differences in demineralized bone matrix particles affect collagen structure, mesenchymal stem cell behavior, and osteogenic potential. J Biomed Mater Res A 2017; 105:1019-1033. [PMID: 27943619 DOI: 10.1002/jbm.a.35975] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022]
Abstract
Demineralized bone matrix (DBM) is a natural, collagen-based, osteoinductive biomaterial. Nevertheless, there are conflicting reports on the efficacy of this product. The purpose of this study was to evaluate whether DBM collagen structure is affected by particle size and can influence DBM cytocompatibility and osteoinductivity. Sheep cortical bone was ground and particles were divided in three fractions with different sizes, defined as large (L, 1-2 mm), medium (M, 0.5-1 mm), and small (S, <0.5 mm). After demineralization, the chemical-physical analysis clearly showed a particle size-dependent alteration in collagen structure, with DBM-M being altered but not as much as DBM-S. DBM-M displayed a preferable trend in almost all biological characteristics tested, although all DBM particles revealed an optimal cytocompatibility. Subcutaneous implantation of DBM particles into immunocompromised mice resulted in bone induction only for DBM-M. When sheep MSC were seeded onto particles before implantation, all DBM particles were able to induce new bone formation with the best incidence for DBM-M and DBM-S. In conclusion, the collagen alteration in DBM-M is likely the best condition to promote bone induction in vivo. Furthermore, the choice of 0.5-1 mm particles may enable to obtain more efficient and consistent results among different research groups in bone tissue-engineering applications. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1019-1033, 2017.
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Affiliation(s)
- B Dozza
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, via G. C. Pupilli 1, Bologna, 40136, Italy
| | - I G Lesci
- WAPH Technology Corp. 1920 N Commerce Parkway, Weston, Florida, 33326
| | - S Duchi
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - E Della Bella
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, via G. Massarenti 9, Bologna, 40138, Italy
| | - L Martini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - F Salamanna
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - M Falconi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Division of Human Anatomy, Alma Mater Studiorum University of Bologna, via Irnerio 48, Bologna, 40126, Italy
| | - S Cinotti
- Cell Culture Centre, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), via Bianchi 9, Brescia, 25124, Italy
| | - M Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - E Lucarelli
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - D Donati
- Osteoarticolar Regeneration Laboratory, 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, via G. C. Pupilli 1, Bologna, 40136, Italy
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Mattiucci G, Morganti A, Farioli A, Frakulli R, Cellini F, Arcelli A, Bertini F, Forni F, Fuccio L, Farina E, Ronchi L, Guido A, Macchia G, Cammelli S, Falconi M, Valentini V. Prognostic impact of preoperative serum CA 19-9 level in pancreatic cancer: a pooled analysis. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bertani E, Fazio N, Radice D, Zardini C, Spinoglio G, Chiappa A, Ribero D, Biffi R, Partelli S, Falconi M. Assessing the role of primary tumour resection in patients with synchronous unresectable liver metastases from pancreatic neuroendocrine tumour of the body and tail. A propensity score survival evaluation. Eur J Surg Oncol 2017; 43:372-379. [DOI: 10.1016/j.ejso.2016.09.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 02/08/2023] Open
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Partelli S, Cirocchi R, Crippa S, Cardinali L, Fendrich V, Bartsch DK, Falconi M. Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg 2016; 104:34-41. [PMID: 27706803 DOI: 10.1002/bjs.10312] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/02/2016] [Accepted: 08/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of asymptomatic, sporadic, small non-functioning pancreatic neuroendocrine neoplasms (NF-PNENs) has increased in recent decades. Conservative treatment has been advocated for these tumours. The aim of this study was systematically to evaluate the literature on active surveillance and to compare this with surgical management for asymptomatic sporadic small NF-PNENs. METHODS PubMed, Embase and the Cochrane Library were searched systematically for studies that compared the active surveillance of asymptomatic, sporadic, small NF-PNENs with surgical management. PRISMA guidelines for systematic reviews were followed. RESULTS After screening 3915 records, five retrospective studies with a total of 540 patients were included. Of these, 327 patients (60·6 per cent) underwent active surveillance and 213 (39·4 per cent) had surgery. There was wide variation in the tumour diameter threshold considered as inclusion criterion (2 cm to any size). The median length of follow-up ranged from 28 to 45 months. Measurable tumour growth was observed in 0-51·0 per cent of patients. Overall, 46 patients (14·1 per cent) underwent pancreatic resection after initial conservative treatment. In most patients the reason was an increase in tumour size (19 of 46). There were no disease-related deaths in the active surveillance group in any of the studies. CONCLUSION This systematic review suggests that active surveillance of patients affected by sporadic, small, asymptomatic NF-PNENs may be a good alternative to surgical treatment.
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Affiliation(s)
- S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - R Cirocchi
- Department of Digestive and Liver Surgery Unit, St Maria Hospital, Terni, Italy
| | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
| | - L Cardinali
- Department of Surgery, Polytechnic University of Marche Region, Ancona, Italy
| | - V Fendrich
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany
| | - D K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps-University Marburg, Marburg, Germany
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, 'Vita-Salute' University, Milan, Italy
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Muffatti F, Tamburrino D, Partelli S, Lopez C, Albers M, Milanetto A, Pasquali C, Manzoni M, Toumpanakis C, Fusai G, Bartsch D, Falconi M. Long-term comparison of conservative management versus surgery for nonfunctioning pancreatic neuroendocrine tumors less than 2 cm affecting patients with men1 syndrome. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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48
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Reni M, Zanon S, Balzano G, Passoni P, Costantino A, Pircher C, Chiaravalli M, Nicoletti R, Arcidiacono P, Pepe G, Crippa S, Doglioni C, Fugazza C, Ceraulo D, Falconi M, Gianni L. Randomized phase 2 trial of nab-paclitaxel plus gemcitabine, ± capecitabine, cisplatin (PAXG regimen) in unresectable or borderline resectable pancreatic adenocarcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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49
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Berardi R, Torniai M, Pusceddu S, Spada F, Ibrahim T, Zichi C, Antonuzzo L, Ferolla P, Rinzivillo M, Silvestris N, Partelli S, Ferretti B, Bongiovanni A, Giustini L, Di Costanzo F, Delle Fave G, Fazio N, De Braud F, Falconi M, Cascinu S. Prognostic impact of the cumulative dose and dose intensity of everolimus in patients with pancreatic neuroendocrine tumors (PNETs). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Cicchese N, Panzuto F, Rinzivillo M, Merola E, Capurso G, Partelli S, Manzoni M, Pucci E, Iannicelli E, Pilozzi E, Falconi M, De Fave G. Reassessment of proliferative activity at disease progression in neuroendocrine neoplasms. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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